Distributor:

Bearjen Gifts Company

Route #1, Box 586

Phone: 1-479-885-1218

London, Ark, 72846

http://www.geocities.com/bearjenco
 

FAST ACTION ORDER FORM

IMPORTANT INSTRUCTIONS!

1. Print, complete, and mail form with all required information.

2. Print clearly in order to ensure a prompt and accurate delivery.

3. Remember to indicate style, size, color, and etc. whenever necessary.

4. Please double check the order, amount due, etc. and correct mistakes.
 
1. Name: _______________________________________________________
 
2.  Address: __________________________________

3. Apt#:

 ___________
 
4. City: ___________________

5. State:

 __________

6. Zip:

 ___________
 
7. Phone:  (___)- ________________

8. Email:

 __________________________
 

Product #

Description

Color/Size

Quantity

Unit Price

Total Amount
           
           
           
           
           
           
           
           
 

Packing and Shipping Chart
 These charges represent only a part of the actual cost, we'll pay the rest! Please add the proper amount if your the total of your order is:
up to $14.99

add $7.95

 from $30.00-$34.99

add $9.15
from $15.00-$19.99

add $8.25

 from $35.00-$39.99

add $9.75
from $20.00-$24.99

add $8.55

 from $40.00-$44.99

add $10.75
from $25.00-$29.99

add $8.85

 from $45.00-$49.99

add $11.35
 *allow 2-4 weeks for delivery. over $50.00

add $11.75
  Sub-Total $________
+ Sales Tax $________
+ S&H Fees $________
= Total Amt $________
 

The total amount of my order is $_________ including any applicable sales tax and S&H charges will be paid by ( check one) [  ] Money Order [  ] PayPal
 

[  ] Please send my FREE Bearjen Gifts "World of Products" Catalog today!

[  ] Please send my FREE information on how to get a FREE Satellite TV System!

You will be contacted by phone or e-mail within 24 hours to confirm your order!
 

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